Medical device with communication, measurement and data functions

ABSTRACT

A medical diagnostic and communications apparatus with audio output comprises an electronic processor for processing stethoscope signals and secondary audio signals. An electronic stethoscope sensor is contained within a housing for transducing body sounds to electronic signals, and is operatively connected to the electronic processor. One or more secondary audio signal sources operatively connects to the electronic processor. A common audio output is connected to electronic processor to convert electronic stethoscope signals or secondary audio signals to acoustic output. These sounds may be produced separately or mixed.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.09/412,140, filed Oct. 5, 1999 now U.S. Pat. No. 7,346 174 (to issue asa patent on Mar. 18, 2008), which is based on Provisional ApplicationNo. 60/103,018 filed Oct. 5, 1998.

FIELD AND BACKGROUND OF THE INVENTION

The present invention relates to a medical communications, informationand measurement device with multiple functions built into the same unit,to produce a portable device. The preferred embodiment is in the form ofa stethoscope-like device with expanded, general-purpose medicalmeasurement, information and communications functions, beyond the basicauscultation functions. However the invention is not restricted to sucha configuration, and may also be built in the form of an information andcommunications device without sensing or measurement capability. Theinvention can also be built in a form suited to other work environmentsoutside the medical field, where the combination of functions is alsobeneficial. The invention also covers methods for accessing medical andother information and digital data via a portable device. The benefitsof the invention relate to the integration of digital wirelesscommunications and information access in the work environment, usinguser-friendly interface methods, in order to make information retrieval,information management, and communications an integral part of workprocess.

A problem encountered by medical workers is that many measurement andinformation means used in their work are not portable, or areinconvenient to integrate into the work flow, requiring the worker todivert attention from the patient or move from the patient bedside toaccess the information or measurement means. Computers are provided forpatient and medical information, but these are usually fixed in specificlocations. When such means are portable, they are embodied in discretedevices which are single-purpose, rather than being embodied in aconvenient, combined or integrated means for use and portability. Forexample, a pager is convenient to carry, but provides only a singlefunction. The same applies to cell phones, stethoscopes, blood pressurecuffs, oximeters, and nonmechanical information devices such as books,journals and reference materials. All of these devices are discrete, andsingle-purpose, and require the worker to carry multiple devices or usediffering means for accessing information, making measurements orperforming communications and recording tasks.

Stethoscopes are carried by almost every physician, nurse or medicalworker during working hours. Stethoscopes have been limited to specificfunctions—primarily auscultation and blood pressure measurement. Themajority of stethoscopes are mechanical devices, however a number ofelectronic versions have been reported, with some communicationscapability, limited to the transmission of auscultation sounds viainfrared or telephone. Some electronic stethoscopes have included someadditional measurement capability, such as heart rate or time intervalmeasurements.

However, the transition from a mechanical to an electronic stethoscopeintroduces the potential to expand the functionality of the stethoscope,using it as a more general-purpose electronic platform for otherfunctions that are useful to the medical worker. The form factor of thestethoscope allows it to be worn comfortably around the neck orshoulders, and the audio input and output functions can be used forother applications beyond auscultation. The fact that it is carriedaround so extensively in the medical setting makes it an ideal platformfor many additional functions of an electronic nature.

While the descriptions herein describe the use of the invention in amedical setting, the invention is not limited to medical applications.The same combination of elements described herein may be used in variousother applications. While then preferred embodiment includes astethoscopes function, other embodiments of the invention may includeother elements of the invention, and omit the stethoscope function. Theunderlying structure of the invention, and the methods associatedtherewith, concern the advantages obtained by combining various elementsto form a system that is easier to use and provides new functions andmethods as part of the work flow, that were not previously practical orsimple.

SUMMARY OF THE INVENTION

The present invention addresses the problem of multiple devices in theworkplace, and exploits the potential for a unified electronic platformwith integrated digital functions, by embedding different functions intoa single device. The preferred embodiment is in the form of astethoscope to be used in the medical work environment. A key innovationis the transformation of the stethoscope into a multiple-use device. Ina more general sense, the benefit of the invention is to bringinformation, measurement and communications technology into the workflow. This is especially of value in medicine, where the use ofcomputers and other electronic equipment, especially of an informationaland data processing nature, is a diversion from the patient or thebedside.

Stethoscopes have been reported that have infrared communications, PCcommunications, and telephonic communications. However, the purpose ofthese links is primarily to transfer auscultation information i.e. forremote listening or recording of sounds. The present invention goesbeyond these limitations to include new communications, storage andprocessing functionality, for the transfer, storage and processing ofdata besides auscultation sounds, and the local storage of data andinformation that is of a more general nature. Examples of suchinformation include, but are not limited to; patient records includingbut not limited to patient history, sounds and images; pharmaceuticaldatabases including but not limited to drug dosage and druginteractions; medical research information including but not limited toreference sounds, diagnoses, images, and research results; insuranceclaim, policy and benefit information; and billing information. Thesedata can be stored locally on the device, or communicated via thecommunications links embedded in the invention. The communicationscapability includes, but is not limited to, wireless, infrared, andcabled connections to telephones, telephone systems, computer networks,and the Internet.

Finally, the user interface of the present invention introduces novelfeatures and methods not previously associated with stethoscopes orinformation access and communications devices in general, includingvoice recognition, speech recognition, data-to-speech, text-to-speech,and audio prompting. Such user-friendly interfacing is a key innovationfor a portable device, where small keyboards and pen input have been therule.

When the embodiment excludes the stethoscope function, the invention maycomprise other elements for medical and other informationcommunications, storage and processing. The invention then provides theworker with convenient user interface, communications and processingcapability.

The invention comprises both a device, or physical embodiment, andmethods associated with the use of the device in a wider system.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram of the major functions and sub-systems of thedevice of the invention;

FIG. 2 is a block diagram showing the audio mixing of auscultationsounds and alternate audio sources;

FIG. 3 shows one physical embodiment of the device with integration ofmultiple functions housed in a single device;

FIG. 4 shows a binocular virtual display means built into thestethoscope headphone assembly; and

FIG. 5 shows communications and data access methods and functions.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The invention consists of a device comprising a number of sub-systems,with each sub-system comprising certain elements, which areoperationally connected. The uniqueness of the invention does notrequire that all sub-systems and elements exist together in the device,since the invention may comprise a subset of the elements describedherein. Beyond an actual device, the invention also includes methods,such methods being steps for processing signals, data and information.Those aspects of the invention that comprise methods, typically includethe device as an integral part of the method i.e. the device is used inconjunction with other devices (such as computers or telecommunicationssystems), using a sequence of steps, to form an original procedure ormethod.

The major sub-systems of the device, as shown in FIG. 1 are:

-   (a) A Sensor sub-system (101).-   (b) An Electronics Processing sub-system (102).-   (c) A User Input sub-system (103).-   (d) A Communications sub-system (104).-   (e) An Output/Display sub-system (105).

The sub-systems and their elements are:

Sensor Sub-System 101:

The Sensor sub-system 101 comprises one or more of the followingelements:

-   (a) Stethoscope sensor 110, to sense body sounds.-   (b) Pulse Oximetry sensor 111 to sense blood oxygen level.-   (c) Temperature sensor 112 to detect body temperature.-   (d) One or more additional sensors (113) to sense other    measurements. All of these sensors have in common the capability to    make measurements of external phenomena of a physical or    physiological nature. Examples include electrocardiography    electrodes, glucose measurement means, an ultrasound probe, a video    camera or a barcode scanner for reading labels.

One or more of the above sensors is operationally connected to theelectronics processing sub-system 102 and sensed measurements aretransferred to the Electronics Processing sub-system 102 for furtherprocessing. In the preferred embodiment, the stethoscope or auscultationsensor is present, however this may be replaced be another sensor, usedin addition to other sensors, or the sensor sub-system may be absent,making the invention an information and/or communications device withoutsensing capability.

User Input sub-system 103:

The User Input sub-system 103 provides the operator with control of theelectronics processing subsystem 102. This may be done via a pluralityof control means. Specifically, the User Input sub-system consists ofone or more of the following elements:

-   (a) Microphone 130 for voice input. This microphone is distinct from    the stethoscope microphone and is used for voice input from the user    in the preferred embodiment. However, the microphone may be the same    device used for auscultation.-   (b) Rotary thumbwheel 131, with optional built in push-button    mechanism. In the preferred embodiment, the rotary device is a    digital input device which produces pulses in conjunction with    additional or embedded circuitry when rotated, but an analog    potentiometer may also be used. In the case of the digital    thumbwheel, the wheel may be rotated through 360 degrees. Inputs    from the rotary device are correlated with control or menu    selections. As the rotary device is actuated, feedback may be    provided to the user via audio output or spoken voice to confirm a    selection.-   (c) Keypad, touchscreen or individual buttons 132.

The above input devices allow the user to enter voice information orcommands, use a rotary switch for volume, menu selections or otherentries, or push buttons, pen or touch to enter selections. Thepreferred embodiment includes one or more of these control methods.

The microphone is used for voice or speech input. Voice or speech inputis used in the following manner, and becomes an integral part of thesteps that form many of the methods of the invention:

Voice is recorded as raw or compressed sound signals, for latertransmission, storage, or transcription, such as for medicalrecord-keeping. Voice recognition is performed, for the purposes of useridentification. Voice signals are processed and recognized in the deviceitself, using software and data within the device, or voice may bepre-processed, and voice recognition performed by a remote system. Aremote system is defined as a system that is not part of the device, andwith which the device communicates via the Communications sub-system.Thus remote voice recognition comprises the steps of recording the voicedigitally, optionally pre-processing the sounds, transmitting the signaldigitally to a remote system, the remote system containing voicerecognition means. The results are then transmitted back to the device.

To perform speech recognition, for the purposes of control and dataentry. The speech sounds are processed locally or in a remote system,being converted to commands or data, either locally or remotely. Themethod is analogous to the voice recognition process, except thatsemantics (meaning, commands or data) are derived from the speechsignal.

Electronic Processing Sub-System 102:

The Electronic Processing sub-system 102, provides hardware, firmware,software and storage functionality, and is operationally connected tothe Sensor subsystem 101, User Input sub-system 103, Communicationssub-system 104, or Output/Display sub-system 105. The ElectronicProcessing sub-system consists of one or more of the following elements:

-   (a) Central Processor/Digital Signal Processor 120, which controls    the system and processes data, measurement signals and information.    The central processor may optionally include means for going into a    standby power-saving mode or low clock-speed mode, although this is    not required for the invention to operate.-   (b) Digital Memory 121, which stores programs (software), voice    information, voice recordings, medical data, databases,    measurements, reference measurement information, reference voice    information, and other data necessary for system operations.    Specifically, the data stored may include voice recognition data to    identify the user or owner of the device; speech recognition data to    identify voice commands so that the device may respond to voice    commands; data-to-speech and text-to-speech tables and data in order    to convert data and text to speech output; patient data including    auscultation sounds, patient history, patient image data;    pharmaceutical data including dosage data or drug interaction data;    medical research statistics and information to assist the medical    worker with diagnosis and treatment by providing such data on a    realtime basis; scheduling information for appointments and time    management; insurance data regarding reimbursement for specific    insurance plans, reimbursements and recommended or approved    procedures for given diseases; billing information and storage; and    other data relevant to the treatment of patients and management of    medical information. Algorithms may be included in the memory for    various diagnostic functions and signal analysis functions. The    digital memory may be split into discrete units so that various data    types are stored in specific memories, or the memory may be a single    device. The memory used for storage of reference information is of a    nonvolatile nature or is battery-backed. Nonvolatile technologies    include but are not limited to Flash, EEPROM, or magnetic media. The    memory may be fixed or removable. The memory may contain both data    and program code related to the access and processing of the    abovementioned data and information types.-   (c) Voice recognition sub-system 122, which provides security    features to validate the user's identity to avoid theft or    unauthorized access to information. The voice recognition function    is implemented as a hardware, firmware or software function. The    voice recognition function may optionally include the use of the    Communications sub-system 104 of the invention in order to access    voice verification data from a remote site. In this case, the raw    voice, or a pre-processed version of the voice data may be    transmitted between the remote site and the invention.-   (d) Speech Recognition sub-system 123, which processes signals from    the microphone in order to perform database searches, respond to    commands, store information, or perform speech-to-text transcription    either within the device or remotely via the Communications    sub-system 104 provided in the invention.-   (e) Compression sub-system 124 which compresses signals, voice or    data to provide efficient storage in the Digital Memory 121 and/or    efficient information transfer via the Communications sub-system    104. The Compression sub-system also includes the capability to    de-compress or expand the stored or received data.-   (f) Battery power supply 125, to provide power to all sub-systems in    a portable manner. The supply optionally includes power management    functions to perform power conservation functions, including sensing    of active use or idle time to determine power states.-   (g) Analog Functions 126, including audio input, filtering,    amplification, and output.-   (h) Text-to-Speech system 127 converts stored or received data into    speech for audio reproduction. This includes a data-to-speech    function for converting data or measurements to speech output.

Many of the above functions can be implemented in hardware, or softwareresiding in the memory 121, and processed by Processor 120. Theinvention does not need all of the above features to be functional, butuses one or more of the above in the invention. FIG. 1 shows theelements in schematic form. Their implementation may be in the form ofhardware, software, or firmware, and their relationship may be of asoftware nature, via a central software operating system residing in thesystem.

Communications Sub-System 104:

The Communications sub-system 104, provides digital communications tolike devices, to computers, to computer networks, to the telephonesystem, to the Internet, or to a large external communications network.There are 3 modes of communications provide for, and any one of these isincluded in the invention:

-   (a) Infrared Link 140, which provides wireless communication. An    industry-standard infrared link such as IRDA is likely to be used,    however any communications protocol may be implemented.-   (b) Wired connection via a connector 141, to provide wired    communications.-   (c) Radio communications 142 to provide communications functions.    The radio can implement any one of a number of radio protocols and    functions, including pager functions, cellular communications,    spread spectrum communications, or digital network protocols. These    protocols may include PCS, CDMA, TDMA, IEEE 802.11, the Flex pager    protocol, or digital satellite communications. Wireless    communications using satellite communications protocols is also    anticipated by this invention. In a home environment, the wireless    channel may additionally be implemented by a 900 MHz digital    communications scheme or other domestic wireless protocol. It is to    be understood that this list does not limit the various methods that    may be used.

Software in the Electronics Processor or the Communications sub-systemitself controls the operations of the communications channel. Thisincludes software protocols including, but not restricted to, TCP/IP,PPP, FTP, or other Internet protocols.

The communications function is not critical to all operations of thedevice, but provides unique capability to exchange information withother systems. The Communications sub-system is intended to provideinformation exchange beyond auscultation information, for broadermedical data purposes. The data types include, but are not limited to,any of the data stored in the Digital Memory, and described under theDigital Memory section. In addition, the communications links may beused for regular voice communications of a telephonic or conversationalnature, to provide partial or complete wireless telephone functions. Thecommunications capability further includes the ability to locate thedevice logically or physically, to aid in the location of a medicalworker, such as via the use of the Global Positioning System (GPS) orother positioning system using wireless radio signals.

Many of the methods described in this invention include steps involvingthe Communications sub-system. The steps typically include transmittingdigital data to a remote computer or communications device, andreceiving results digitally. In some cases, the steps includecommunications with or via another portable device such as a handheldcomputer or cellular telephone. In such cases, signals from the devicedescribed by this invention are communicated to a portable deviceincluding but not limited to a cellular telephone or handheld computer.The second device then either processes data internally and transmitsresults back to the first device, or the second device relaysinformation to a remote system using its own communications means. Inthis case, the second device acts as a communications bridge between thedevice and a remote system. It is to be understood that these steps, orvariations thereof, are steps involved in communications between thedevice and remote systems.

Output/Display Sub-System 105:

The Output/Display sub-system 105 provides information output capabilityto the invention. Any one of a number of methods can be used, singly orin combination. The system includes one of the following:

-   (a) Loudspeaker 150 to provide audio information output.-   (b) Headset or earphones 151 to provide audio information output.-   (c) Miniature virtual display device 152, which provides    high-density information display by placing the eye close to the    display screen and viewing a virtual image.-   (d) Small display screen 153, provides information, and/or a user    interface.

The data that is to be displayed may be from a variety of sources,including text and graphics data. The data format may take any form,including HTML and derivatives thereof.

In one embodiment, the audio output means is shared by the auscultationfunction and other functions. This is a unique aspect of the invention,since listening to a stethoscope is a common practice in the medicalwork environment, and the invention provides for listening to numerousother audio and information sources via the same means, making audio anatural means of information communications in the medical environment.The information output is also private, allowing workers to listenwithout patients overhearing.

Functional Description

The invention is used by medical workers to make physiological patientmeasurements, access data, store information, access information, makemedical diagnoses and/or communicate with computers and people. It isthe purpose of the invention to provide portable digital functions tomedical workers, in order that they may take advantage of advances innumerous digital technologies as an integral part of their workflow.Such digital technologies includes measurement, information, andcommunications functionality. The purpose of these functions is to makeinformation and communications an integral part of the work flow ofmedical workers, by uniquely combining the elements of the invention ina portable form, and using user-friendly, timesaving methods to accessdata and information. This promises to change the way that medicalworkers use information, making information an integral part of medicalpractice, available quickly and easily when needed. The flow ofinformation includes facilitating the transfer of information to thepatient as well, since the methods described by the invention providefor the transmissions of digital information to the patient.

Specifically, the invention uses one or more of the followingtechnologies:

-   (a) Speech recognition and voice recognition.-   (b) High-density low-power memory.-   (c) Wireless analog or digital communications.-   (d) Text-to-speech and data-to-speech technology.-   (e) Low-power electronics using a portable power source.-   (f) Wide area digital communications technology, such as the    Internet and POTS.

While the invention may be built without stethoscope or medicalmeasurement functionality, the preferred embodiment of the deviceincludes an electronic stethoscope or other physiological measurementmeans, combined with one or more of the following functions:

-   (a) Pager.-   (b) Cell phone.-   (c) Wired and/or Wireless Communication to transmit requests for    data and receive data from a database.-   (d) Built in database of auscultation sounds, patient data, medical    information, and/or pharmaceutical information.-   (e) Heart Rate Monitor.-   (f) Blood Oximetry monitor.-   (g) Korotkoff signal processor to assist with blood pressure    measurements-   (h) Blood Pressure Monitor-   (i) Thermometer-   (j) Speech recognition (SR) and/or voice recognition (VR) system-   (k) Speech generation text-to-speech or data-to-speech system-   (l) Database search engine-   (m) Internet protocol communications-   (n) Internet interface for performing internet searches-   (o) Automated diagnostic software to perform signal and data    analysis and guide medical diagnostics-   (p) Natural Language Processing (NLP) to convert spoken input into    command, control and search functions-   (q) Video input and output means, to input, record, playback and    display static/still and dynamic/moving images.

The above list is not an exhaustive list of all technologies andfunctions. Specific functions, methods and applications are describedbelow.

Various methods are described as part of the invention, for manipulatingsignals, measurements, data and information.

One method relates to access of medical information. The medicalinformation includes, but is not limited to, drug dosage information,drug interaction data, patient records, medical research information,medical protocol and treatment information, medical insuranceinformation, patient history, billing information, medical procedures,and other information related to the treatment of patients. The methodof working with this information includes the following steps: The userenters commands or requests via the User Input sub-system, using themeans provided. Such means include keystrokes, touchscreen, rotary dial,or speech input. The Electronic Processing sub-system processes thecommands, and searches the data stored in the Digital memory. Theresults are then formatted and output via the Output sub-system. In oneembodiment, the input means is speech via the microphone, and the outputmeans is audio, using text-to-speech means. The audio output means mayoptionally be the same means as used for auscultation sound output in anembodiment that includes auscultation means. In another embodiment, theoutput means is the virtual display device, meaning a small screen,viewed at close proximity to the eye, to provide an image to the viewerthat is perceived to be larger than the actual screen itself. Theseoutput means are not mutually exclusive. The virtual screen may provideeither monocular or binocular viewing means.

A second method uses the Communications sub-system and a remote datasource. The method is as follows: The user enters commands or requestsvia the User Input sub-system, using the means provided. Such meansinclude keystrokes, touchscreen, rotary dial, or speech input. TheElectronic Processing sub-system processes the commands, and transmitsthe request to a remote computer system containing the requested dataand information. The remote system performs the steps of searching forappropriate data. The results are then formatted, transmitted back tothe device, and output via the Output sub-system. In one embodiment, theinput means is speech via the microphone, and the output means is audio,using text-to-speech means. In another embodiment, the output means isthe virtual display device.

It is to be understood that alternatives which are covered by theinvention include performing some of the steps within the remote system,such as speech processing and text-to-speech conversion. Variations ofthe method and structure described above can achieve the same result,and the above descriptions should not be construed as limitations on thestructure and method of the invention, or of the type of data for whichthe invention is useful. For example, the speech recognition functions,or the text-to-speech functions can be performed by a remote system,decreasing the processing burden on the portable device carried by theuser. Such a method still achieves the result of being able to enterspeech commands for searching medical information systems, and receivingspeech output. A second variation of the method includes the use of asecond portable communications device which is used as an intermediarycommunications means between the first device and a remote system. Forexample, the first portable device might communicate with a cellphone orhandheld computer, which in turn might contain the requisiteinformation, or might in turn communicate with a remote system, actingas a bridge between said first device and remote database system. Thismethod has the advantage that the first medical device uses the wirelesscommunications or storage capability of a more general-purpose computingor communications device such as a handheld computer or cellphone.

A further method included in the invention is the storage of informationrelated to a patient and/or user either locally in digital memory in theportable device, or in the remote system. As an example of such amethod, the following steps would be performed: The user entersinformation via the User Input sub-system. The input is then convertedto a form suitable for storage in a database. The data is then storedlocally in digital memory, or transmitted via the Communicationssub-system to a remote database or handheld computer for storage. Thedata stored may include, but is not limited to, patient name andidentification data, examination results, drug dosage, tests ordered,tests results, physiological measurements, procedures and servicesrendered, billing information, and time and duration of service. If thedata is stored locally in digital memory, the method includes the stepof later transferring the data to a computer system for inclusion in apatient's medical and billing records. An intermediate communicationsmeans may also be used, such as a cellphone, telephone or handheldcomputer, which bridges data communications between the device and aremote computer system. The unique aspects of this method are thecombination of speech recognition, combined with wireless communicationsand the medical data as described. The method includes software forformatting the data into an appropriate database record or document fromthe speech input, when speech input is used. The automation methodincludes the steps of identifying keywords or identification phraseswhich the formatting software uses to allocate information to categoriessuch as tests ordered, test results, measurements, physical findings,times and dates, and other relevant data. This allows the speaker to usea natural language input format, with some limited structure, and usingsoftware processing to partition the data types, and compile a reportwith a more uniform structure. The method also simply allows standardtranscription. In this case, the uniqueness of the invention is theembedding of speech recognition into the process, and in a preferredembodiment, into a portable device.

With regard to the recording of patient record information, it is to beunderstood that patient records may be transmitted both from and to thedevice. Therefore, the user may make a request for a patient record, andhave a remote computer system transmit the patient record to the unitfor review and updating. Such record may include audio recordings,images, test results, and other data specific to the patient.

As a variation of this function, the invention includes a voicerecording method, as follows: The user dictates into microphone 130, thesound is stored digitally, either in raw or compressed form, and thestored recording is then transferred via the Communications sub-systemto a speech recognition system located on a remote computer.Alternatively, the speech recognition function is built into theinvention, and the converted text information is stored and latertransferred to a remote computer for storage and/or printing. Therecorded data record might also include physical or physiologicalmeasurement data, and other automatically or manually generated datasuch as time and date. The inclusion of this function in an informationor measurement appliance obviates the need for a separate dictation orpatient reporting device or service. The computing device thatultimately stores the patient records or transcribes the recording fromspeech to text may be located remotely and accessed via cable,telephone, internet, or wireless link. For example, data from the unitin the form of voice files or data files may be transmitted or emailedfrom the invention to the remote system, or transferred via a cable orinfrared link. The uniqueness of the invention with regard to dictateddata lies in the combination of measurement means used by the medicalworker with voice recording means. A further aspect of uniqueness of thepreferred embodiment is the dual use of the stethoscope audio outputmeans—the audio output means for playback and feedback of voicerecordings may be the same audio output means as that used forauscultation, or it may be a separate audio output means. Thecombination of voice recording means and auscultation means has notpreviously been reported, and is a unique aspect of the invention. Thebenefit lies in the fact that dictation means is no longer necessary asa discrete and separate device from the auscultation device.

While the preferred embodiment of the voice recording system providesfor speech recognition functions either within the device or remotely,it is to be understood that the voice recordings may also be transferreddigitally to a remote device, and manually transcribed to text by aperson listening and typing the dictated text. In this case, thefundamental benefit of the device is that the voice recording means iscombined with the auscultation means such that a common power source maybe used, and audio components common to voice and auscultation may beused, to lower cost, size and weight of the invention. For example, theaudio output means used for auscultation may be the same means used tolisten to recorded voice for review or playback.

In the preferred embodiment, the speech output is provided via the sameaudio output means as that used for auscultation. If a visual displaymeans is used, a miniature display of less than 4 inches diagonalmeasurement is used, or a virtual display device is used. In thepreferred embodiment, the device has the form of an electronicstethoscope, with headphones or earphones and auscultation sensor. Thepreferred embodiment also includes the communications means, which useswireless radio communications means. The preferred embodiment asdescribed does not restrict the invention, since other means may be usedto perform the same methods of data access.

One important aspect of the invention and the methods associatedtherewith, is the validation of access to patient records and medicalinformation. Specifically, patient privacy is becoming an importantproblem, as access to patient data becomes easier. The inventionincludes a method for identifying the personnel requesting informationusing voice as an identification means, recording the request for suchinformation, and validating the authorization for such a request. Themethod includes the following steps: The user (requester) enters a voiceor speech command or identifying voice signal. The voice signal is used,either raw or pre-processed, to identify the user. This identificationstep may be done locally from local storage, or the identification data(voice or voice parameters) may be sent via a communications link to aremote system which contains voice verification or identificationdatabase information. The identity of the user is then performed, andthe request logged for future reference. If a limited number ofauthorized users may gain access to the patient data, as an additionalstep, the voice identity of the user is compared to the authorized list,and approval is either granted or denied. If granted, the requestedpatient information is transmitted to the device via the communicationschannel, or the information is simply transmitted without authorizationif no authorization is required. At a later time, the identity of therequesting person can be checked for each patient. This process allowsmedical workers to access patient data in realtime, but ensures thatrequesters are identified so that fraudulent or unauthorized access canbe verified and prosecuted. The same identification means may also beapplied to the storage of new information is a patient record, in orderto control and audit the authority to modify patient records. This meansof identification can be extended to include telephone or computeraccess, for situations not requiring portable access.

The voice verification method is also applicable as an anti-theft methodfor the portable device. The steps are as follows: The voice identity ofthe user is compared to the an internal voice identification record indigital memory, the identity record of which has previously been stored.If the identity matches, the device continues to operate. If not, thedevice either ceases to operate, or operates with some limitations, suchas time limit or a limited number of functions. This voice verificationmethod may be applied to a wide variety of portable devices which aresubject to removal or theft.

The use of speech or audio output offers broad applicability. Theinvention includes the capability to make physical or physiologicalmeasurements using the Sensors sub-system. The measurements include, butare not limited to auscultation sounds, temperature, blood oximetrylevel, blood pressure, blood glucose level, and other physiological andphysical measurements. The invention includes means for converting suchphysical measurements to medically useful data, such as numericalresults. The numerical or physiological results can then be converted tospeech output to be sent to the user via the audio output means. Thishas the advantage of giving the medical worker patient measurement andtest results aurally. An alternative, of use in a portable device, is todisplay the information on a miniature or virtual display of less than 4inches diagonal measurement. In the preferred embodiment, physiologicalmeasurement results are provided in speech form via the same audiooutput means as that used for auscultation.

The ability to store and transmit patient history and medicalinformation from the device to remote medical diagnostic computersystems facilitates further information processing capability of valueto the medical worker. The invention provides for the remote system toperform automated diagnostic analysis, provide suggested or standardtreatment, and diagnostic or research information. The method alsoallows for the inclusion of solicited or unsolicited voice or displaymessages to be included in a return transmission to the user, such asdrug or medical product information. The method is as follows: Patientcondition information or disease information, or a discrete informationrequest is transmitted from the device to a remote computer system via awired or wireless digital communications link. The patient record ordisease information is then analyzed by a software search system whichmatches potentially useful products, medical research or treatmentinformation with the patient's condition, medical record, or informationrequest. The remote system then optionally combines medical informationto be sent back to the user with product information, and the combinedmessage is transmitted and displayed or played back aurally to the user.An alternative reply method is to perform the matching function asdescribed, and then email or otherwise transmit relevant product andmedical research and information to an email address or data receptionsite associated with the user, and known to the remote computer system.The user then receives email or data which includes product information,medical research, or other useful information related to the patient'scondition or disease in question. The email or data response may takethe form of a discrete transmission to an email account, or simply asearch result stored in a computer system accessible by the requester,such information being formatted and presented to the requester whencommunicating with said computer system, such as logging into theInternet and viewing Web customized pages or links. The user or medicalpractitioner benefits by receiving medical information without having tomanually perform research tasks. The method of the invention can beextended by further transmitting digital data, email or a report to acomputer or data site accessible to the patient, the data responsehaving been compiled as a result of a request entered by the medicalworker into the portable device described by this invention. In thiscase, the patient benefits by receiving medical information and advicedirectly, as a benefit of the medical exam. Information thereforebecomes integral to the practice of medicine, providing the practitionerwith real-time or delayed information distilled to be directly relevantto a given case, and the patient benefits by receiving additionalinformation that can help to educate the patient. In the case of usingpatient medical records to derive search requests, the method providesfor stripping patient-specific information from the search request, inorder to maintain confidentiality.

A further application of the invention is for telemedical diagnosticservices. The method is as follows: The user makes a physiologicalmeasurement such as auscultation, glucose or blood oxygen measurement.The measurement, and optionally voice or system identificationinformation is transmitted via communications means to a central medicalscreening center staffed by qualified medical practitioners or nurses.The communications means in this case might be of a consumer nature,including but not limited to wired telephone, cellphone, or Internetaccess. Once received at the remote medical center, the medicalmeasurements and data are analyzed by said medical practitioners ornurses (analysts). The analyst then communicates with the user, who maybe a patient or caregiver, and recommends a course of treatment oraction resulting from the measurement analysis, and additionalinformation. The return communication may via telephone or email orother data transmission means. The invention provides for themeasurement and communications functions to be combined. If voicecommunications with the medical analyst is included in the method, themicrophone and audio output means used for the communications on theuser end may optionally be integrated into the portable device describedby this invention, and use the same audio output means for auscultation,measurements and voice communications. This allows the user, patient orcaregiver to listen to auscultation sounds and have a telephoneconversation concurrently or sequentially. The communications betweenthe device and the remote analyst includes data for identification andcontrol commands to allow the analyst to control the device operationand read results directly. The communications may optionally includevideo connection to allow the analyst to view the patient whileperforming measurements.

While the telemedical method is preferably performed in real time, amethod which uses email or delayed data transmission is also part ofthis invention. Using this method, the measurements, voice and data areemailed or transmitted via the Internet or other data communicationsservice to a remote site, where an analyst evaluates the information andresponds via data communications means or telephone. The analysis mayalso be performed automatically by signal processing and computeranalysis means. An important aspect of the invention thus used, is theability for the remote system to use identification means to store dataand measurements in a patient database, and use sequentialcommunications records to analyze the progress of the patient from onecommunications to the next. This is especially valuable for an asthma orpulmonary condition, whereby sequential records may be listened to bythe analyst, for baseline and comparison purposes.

The invention may optionally include local measurement or analysiscapability. The steps in the method would thus include the following:Physiological measurements are made, the signals are analyzed within theportable device using signal processing and data processing means, and arecommended course of action is displayed or output via the audio outputmeans. The recommended courses of action include, but are not limitedto—no action, monitor situation, call medical center. In this case, thediagnostic algorithms are included in the Digital memory of the device.

The invention also includes capability to store reference auscultationsounds in Digital Memory. There are two purposes for these referencesignals. In one method, the user can listen to reference sounds in orderto make a manual comparison of a patient's sounds with references inorder to manually determine similarity. In a second method, thereference sounds are used by built in analysis software to compare apatient recording with the reference sounds, in order to perform amatching function to find the most similar sound, and render a potentialdiagnosis.

The telemedicine applications of the invention are enhanced by thecombined functions described in the invention. Specifically, thecombination of stethoscope, oximetry, glucose and/or voice functions,combined with the communications sub-system, allows for measurements andannotated information to be transferred via telephone or datatransmission to a central diagnostic center, along with patientidentification data, for remote evaluation. By including a microphoneand audio mixing in the device, the analyst at the remote site cancommunicate with the patient or caregiver.

A further example of the use of the invention is for communicating witha medical worker. By including a built in pager device, physical locatordevice or cellular telephone, the medical worker has communicationsfunctionality built into a medical information or measurement appliance,obviating the need to carry a separate communications device. Thecommunications functions can be performed via the same audio means asthose used for other audio input and output functions.

The communications means provided in the device may be of ageneral-purpose nature, such as pager or cellphone. While during workinghours, the worker might find the combination of medical measurementfunctions, and specifically auscultation, with communications functionsto be useful, one embodiment of the device allows for the communicationsfunctions to be physically separated or disconnected from thecommunications functions. the worker can therefore carry thecommunications functions in a compact manner without having to carry allcomponents of the invention all the time. In such an embodiment, themedical measurement or output means, such as auscultation sensor,oximetry sensor, or earphones, may be mechanically decoupled from themain body of the device to produce a more compact device.

The productivity enhancement of the invention are enhanced by includingvarious additional Internet and database functions which are easilyactivated by the user. One such example is a request for a database orinternet search related to a patient's history or physiologicalmeasurements. The patient's records, or the user's inputs via voice orkeypad, are converted into an Internet or database search, and theresults provided back to the device, or sent to another destination,such as the user's email address. This service might includetransmission of the physiological or patient information to a diagnosticdatabase for automated diagnosis or peer review. The invention providesthese functions by providing a connection between the point of care andother computing resources via its communications sub-system, either inreal time or via a stored and delayed transmission.

The recordkeeping functions are enhanced by various automatedannotations. These include time, date, personnel on duty, and/or drugand other information entered via voice or barcode. The information maybe transferred to a billing and management system, as well as a patientinformation database. This is an example of how information and data areseamlessly integrated into the patient care process—a central purpose ofthe invention.

One of the problems encountered in medical education is that ofexamining medical students and nurses on their auscultation skills. Theinvention provides a means to administer testing of such skills, usingthe following method: An electronic stethoscope with auscultation meansis operatively connected to a personal computer, or remote computersystem via a digital communications means. The computer contains adigital memory with various heart, lung and other body sounds, which aretransmitted via the communications means to the stethoscope, allowingthe student to listen. Included with the auscultation sounds, is a voicemessage stating a multiple-choice question. The student then listens tothe sound, and is provided with a means, either on the stethoscope or ona connected device such as a personal computer, to enter a selectedanswer, which is then transmitted to the remote computer system forgrading. The system optionally has a voice recognition identificationmeans to validate the identity of the student taking the test.

This educational method can also be applied to a learning environment.In this situation, the invention consists of an electronic stethoscope,combined with a database of recorded heart, lung and other body sounds,recorded on a digital medium such as, but not limited to, compact disk,floppy disk, or digital memory. Alternatively, the sounds may betransmitted via a communications medium such as the Internet. Theinvention then provides a means to connect the stethoscope operativelyto facilitate the playback of the sounds via the stethoscope's audiooutput means. Additional controls are provided to allow the listener toreplay, skip, or otherwise control the playback of these sounds. Theuniqueness of the invention lies in the facility to reproduce therecorded sounds through the same audio means as is used by thepractitioner to listen to perform auscultation, rather than using aheadphone set connected to an audio system. This ability makes thestethoscope into a teaching tool. The transmission of the soundsdigitally to the stethoscope is also unique, and is an improvement overprevious methods in that sound quality is maintained. The listener istherefore listening to digitally transmitted auscultation sounds througha stethoscope, rather than using a general-purpose audio system. Byusing the Internet or other wide area network system to perform thesetasks, distance learning and teaching is facilitated, which has not beenreported before.

All of these combinations are unique in that they combine medicalmanagement functions into a wearable device. Previous inventions mightprovide some of these functions, but do not possess the convenience ofcombined functions, which allows a more integrated functionality,ease-of-use and integration of patient measurements and databaseinformation.

One of the unique aspects of the invention, is the combination of audiosources for information and measurement output. FIG. 2 shows afunctional diagram of one embodiment of the invention, whereby theauscultation sounds and measurement and information sources are mixedand reproduced via the same audio output mechanism. Auscultation soundsfrom sensor 201 are processed. The microphone 202 provides an inputsource that can be mixed with the auscultation signal. Information datafrom the text-to-speech (data-to-speech) processor 203 is also accessedor generated, and converted to speech. Any other sound source with noauscultation content 204 is also available to the mixer. It is thenmixed or multiplexed by mixer/multiplexer 205, in order to reproduce itthrough the same audio output means—speaker 206 or headphones 207. Inthe preferred embodiment, measurements such as heart rate or timeintervals are computed and converted to speech to be played through thesame headset used for auscultation. The preferred embodiment includesthe stethoscope sensor, and a data-related voice source, such astext-to-speech processor 203 or recorded sound segments from a storedsource, such as 204. The mixing function also allows for the mixing ormultiplexing of ambient sound with auscultation sound. This may beautomated, whereby the sound source is switched to auscultation when thesystem senses that the auscultation sensor is in use. Such sensing canbe done by measuring the signal amplitude and/or signal frequencycontent from the auscultation sensor. When the amplitude increases, orthe sub-sonic frequency content increases, the system switches toauscultation sensing. The mixer is thus intelligent, and is able todetermine the source of the sound to be presented to the output means.

The digital rotary switch provides an easy-to-use user interface. As theknob is rotated, the display or voice output indicate modes and/or menuselections to the user. Once the user gets to the desired option, therotary switch is pushed to “click” (select) the option.

The output devices 152 and 153 also provides a unique method ofdisplaying information on a small medical device. The virtual display152 allows images to appear larger than they actually are, allowinglarge images to be viewed on a small device. In one preferredembodiment, the device includes a stethoscope sensor, and a virtualdisplay device. Alternatively, the display device may be a small display153, possibly, but not limited to being less than 4 inches diagonally,which displays data, images and the user interface.

Another output means is the conversion of digital information toaudio/speech output. This is done in the Electronics Processingsub-system, and allows digitally-stored information to be output via anaudio means such as speaker or headphones. Information might includeheart rates that are measured from the auscultation waveform, orintervals between events within a heart cycle. In the preferredembodiment, the measurements are performed automatically i.e. by asoftware function. An alternative is that the waveform is reproduced,and the user pushes a button at the time of each event being measured.The electronics processor then finds the nearest events to the buttonpush times, and produces a measurement, provided in voice format via theaudio output device.

The digital memory 121 is used to store programs, data, voice recordingsand other data required for correct operation and features. Asub-section of this memory may be placed on a removable medium,providing an alternative method of data exchange. The memory means maybe any digital storage medium, and may be partitioned physically andlogically into RAM, ROM, NVRAM, program memory, data memory, audiomemory, or other partition that provides for an efficient design.

Some of the benefits of the invention lie in the combination of corefunctional units or sub-systems, which can be shared by variousfunctions. Therefore, the battery pack can be used as a power source forcommunications, measurement and computing functions. This is unlike theseparate device situation, whereby each device has its own power source.A similar benefit is derived from using a central processing unit tomanage all measurement, input, output and communications functionsthrough various software modules. This provides a potential for costsaving over physically separating these functions.

The combination of functions made possible by this invention provide aunified, convenient platform for functions and features useful in themedical environment, whose unification adds significantly to theconvenience and ease-of-use of these functions compared to a situationwhere each is offered separately.

While the invention has been described in the medical work environment,the same elements may be combined to form a wearable information,measurement and communications device for other applications. Theseother applications do not materially change the combination of elementsin the invention, but do change the content of the information. Otherexamples include legal information and databases, law enforcement andsecurity situations, inventory management, whereby the informationrelates to products and materials in a warehouse, and other situationswhere communications, measurement, input, and output are combined in aunique manner.

While the invention describes various potential combinations of elementsand methods, and is intended to cover a broad range of options, it isimportant to specifically describe some preferred combinations ofelements. While this brief list includes specific combinations, it is tobe understood that other combinations are covered by this invention. Theterm “stethoscope” shall include devices that use ultrasonic signals toproduce audio representation of body functions:

-   (a) A device comprising a stethoscope combined with a pager means.-   (b) A device comprising a stethoscope combined with a cellular    telephone.-   (c) A device comprising a stethoscope combined with a voice    recording means.-   (d) A device comprising a stethoscope combined with a wireless    communications means using spread spectrum digital communications.-   (e) A device comprising a stethoscope combined with wireless    communications means using 900 MHz digital communications.-   (f) A device comprising a stethoscope and oximetry measurement    means. Such combination may be housed within the same housing, as a    combined portable instrument with portable power source, such power    source potentially being separate or shared by both stethoscope and    oximeter.-   (g) A device comprising physical and physiological measurements    means, with speech output of measurement results.-   (h) A device comprising physical and physiological measurement    means, with speech output of measurement results, and means for    modifying the language used for output.-   (i) A device comprising physiological measurement means combined    with speech recognition means.-   (j) A device comprising physiological measurement means for    auscultation, combined with speech recognition means.-   (k) A device comprising a medical database containing pharmaceutical    information including but not limited to combined effects of various    drugs, and drug dosage requirements based on patient physical    characteristics, such database being combined in said device with    speech recognition means to access said database using speech input.-   (l) A device comprising a medical database as defined in (k),    whereby the database output means is via audio output, in one or    more languages.-   (m) A device comprising a medical database as defined in (k),    whereby the database output means is via a miniature virtual display    placed close to the eye which generates a virtual image.-   (n) A device comprising speech recognition means, digital memory    means, and software to interpret a (primarily) medical vocabulary,    whereby speech recognition means is combined with software to    generate structured patient medical records database information    from freeform unstructured speech input. This is commonly referred    to as Natural Language Processing (NLP).-   (o) A device as described in (n) whereby speech recognition means is    used to access patient medical records from a remote system via a    wireless digital communications means.-   (p) A device comprising physiological measurement means, combined    with voice recognition means, whereby voice recognition means    determines the level of device functionality. This is used for    securing the device.-   (q) A device as described in (o) combined with voice recognition    means, local or remote, whereby voice recognition is used to    determine access to patient records.-   (r) A device comprising electronic stethoscope combined with medical    information database, whereby medical information is searched via    speech recognition means, and medical information results are output    via an audio output means, said audio output means being the same    audio output means used for auscultation sounds.-   (s) A device comprising a stethoscope combined with a miniature    virtual display device, said display producing a virtual image when    placed close to the eye.-   (t) A device comprising a portable communications device with spread    spectrum digital communications means and miniature virtual display    device.-   (u) A device as described in (r) connected via said spread spectrum    communications means to a remote medical database system, said    database system including medical research information or patient    records.-   (v) A device comprising a stethoscope, communications means, and    control means operating via said communications means, whereby a    remote user can control stethoscope operations and listen to    auscultation sounds.-   (w) A device as described in (v) whereby communications means    carries voice and auscultation signals simultaneously or    alternately.-   (x) A device comprising a stethoscope with additional microphone and    multiplexing and mixing means to multiplex or mix sounds from    auscultation source and microphone, whereby sound source is    determined by auscultation source signal amplitude and low frequency    characteristics.-   (y) A device as described in (v) whereby remote database system    includes software to search medical database and generate medical    research or product information reports based on patient medical    record contents.-   (z) A device as described in (y) whereby patient identity is removed    from search request submitted to database, in order to protect    patient privacy.-   (aa) A stethoscope with voice recording means, whereby voice    recordings are transferred via a digital communications means to a    personal computer.-   (bb) A stethoscope with voice recording means, whereby voice    recording are transferred to a personal computer or remote computer    via digital communications means, said computer containing speech    recognition means to convert said voice recordings to text-based    reports and information records.-   (cc) A stethoscope with digital memory means, said memory containing    auscultation sound recordings for various medical conditions,    combined with audio output means to listen to reference auscultation    sounds, and recorded auscultation sounds, for the purposes of    comparing patient sound to known one or more recordings, in order to    assist listener in making a diagnosis.-   (dd) A stethoscope as in (cc) combined with pattern recognition    means, such that patient sounds is compared to reference sounds, and    suggested matched sounds and diagnoses are presented to the listener    via auscultation audio output means.-   (ee) A stethoscope combined with infrared digital communications    means, said communications means being used for transmission of    auscultation sounds and digital voice recordings.-   (ff) A portable wireless communications device with facility to    connect physiological sensing and output means using the same power    source, said connection being mechanically designed such that the    communications means can be mechanically separated and operated    independently from the physiological sensing components.-   (gg) A software program whereby patient records are scanned for    disease and treatment-related keywords, and patient-specific    identification data are removed; said resulting disease and    treatment information being applied to a search request for medical    and product information; said medical and product information being    transmitted via a communications means to said patient, or patient's    caregiver or physician.-   (hh) A portable video recording means combined with a wireless    communications means, said wireless communications means having    capability to transmit video images to a patient record database    stored on a remote system operatively connected to said video    recording system. By video, is meant a means for capturing both    still and moving images.-   (ii) A stethoscope with wireless communications means and Internet    protocol software to send and receive email and web page data over    the Internet.    Physical Embodiment

FIG. 3 shows one physical embodiment of the device, to illustrate theintegration of functions into a single unit. This is a preferredembodiment, but is only one way that the invention may be physicallypackaged. The main body shown in FIG. 3 may also take the form of ageneral purpose handheld computer with medical sensors physicallyattached or cabled to the handheld computer to provide the samefunctionality as shown in FIG. 1. In this embodiment, most of theelectronic processing 102, user input 103, and output/display functions105 would be provided by the handheld computer's built in functions.

The device consists of an enclosure with elements of the design. Inputfrom the user is performed via keypad 132, rotary dial 131 and/ormicrophone 130. The microphone may optionally be placed on the headsetshown by microphone 130 a, which has the benefit of proximity to theuser's mouth for speech input.

As an alternative or adjunct to input means 131 are shown a joystick 131a and an internal motion sensor 131 b, or 131 c placed in the headset.The joystick is used to provide 2-dimensional input, with a possiblepushbutton for affirmative selection of a control option. The motionsensor provides 3-dimensional and rotational sensing to allow the userto control the device by moving the main housing through space inspecific directions. Similar actions can be done using head movements,using the headset-mounted 131 c.

Output of information is provided via a number of potential means,including display 153, virtual display 152 or 152 a, and/or headphones151. Placing the virtual display on the headset as shown in 152 a hasthe benefit of providing binocular vision. The headset may bedisconnected via connector point 401.

Communications is effected via connector 141, Infrared communicationsport 140, and/or wireless communications means and antenna 142. Theantenna may optionally be extended into the headset cable assembly.

The digital memory 121 a means may optionally be removable andaccessible from the outside of the enclosure, as shown.

Sensor means are provided by stethoscope or auscultation sensor 110,oximetry sensor 111, or other sensor 113 and 113 a, which may be abarcode scanner, image sensor, video/camera input lens and imagingsensor, or other sensing means, such as ultrasonic probe. An ultrasonicprobe may be used as the means for doing auscultation or blood flowmeasurements, in place of the more conventional acoustic sensor. Bystethoscope, is thus meant any such means for performing auscultation.Ultrasound may also be used in this invention for imaging, such as forechocardiography or obstetrics, using the display means for viewingimages. The various sensor means may be detachable or removable, suchthat they become accessories to be added to the basic housing. In such acase, the housing is designed such that there are cavities for insertingthe various sensor and measurement means. The image sensor means allowsfor the inclusion or attachment of close-up lenses or ear-tip probes, inorder to view eardrums, nostrils, throat, or take close-up images ofskin or other body parts, for the purposes of recording in medicalrecords.

Sensor 113 a is shown to have an orifice through the housing. Thisallows for sensors which measure breath, or optical transmissioncharacteristics. In the case of breath, either lung capacity or breathchemistry may be measured by the patient breathing through a tubeattached to the main housing. In the case of an optical measurement, thepatient might insert s finger into the orifice, which may in this casebe closed at one end. Sensor 111 may operate in a similar manner. In allcases, the invention allows for the inclusion of disposable sensorsand/or covers to ensure sterility. Sensor 11 may also be a reflectiveoptical sensor. An alternative means of connecting additional sensors tothe device include using electrical cabling, connected to durable ordisposable sensors.

Convenient physical enclosure features are provided by a belt clip 403,which has previously not been associated with a stethoscope, and amovable cover 402 to protect the medical or other sensing means. Poweris provided by energy source 125, which may be a battery or otherelectrical energy source. Contacts 404 or 404 a are located on thesurface of the enclosure, and provide a means for clipping the device toa charger, suspended by the earpiece or held around the case, to providecharging while not being used. Alternatively, an inductive/magneticconnection may be used via coil 405 placed inside the device, which canprovide inductive connection to an external charging circuit. This coilmay also be used as a communications means, using higher frequencies totransmit data, while lower frequencies are used for power transfer. Theentire housing may be sealed to allow for sterilization, or disposablecovers may be attached to protect the device itself from touchingpatients.

FIG. 4 shows further detail of a preferred embodiment of a binocularvirtual display means, built in to the stethoscope headphone assembly. Aheadband 406 is attached to the headphone assembly, such that it can bemoved from a position planar to the headset (out of the way, potentiallyfitting into a slot), to a position at approximately right angles to theheadset such that it becomes a support that fits over the top of theviewer's head aligning the eyepieces of the display 152 a to theviewer's eyes, and holding the headset/display in position. The headband406 may be of a solid material, or a flexible substance that adapts tothe shape of the viewer's head. FIG. 4 also shows an eyepiece distanceadjustment 407, to allow the distance between the eyepieces of abinocular display to be adjusted to the viewer's preference. Thisdistance is adjustable such that it is somewhat independent of thedistance between the earpieces 151. The eyepieces 152 a allow fordioptric adjustment or insertion of prescription lenses, to furthercustomize viewing quality to the needs of the viewer. Such accommodationis also provided for in a monocular eyepiece 152. Any convenient meansfor attaching or positioning the display may be used, for example, usinga support which rests on the viewer's nose.

FIG. 5 shows the functional aspects of many of the methods in thisinvention. The device is shown as 601 a-e. In one embodiment, the device601 a communicates with a handheld computer 602 with built in database.The database might include many forms of data, as discussed elsewhere inthis description. The device communicates with the computer 602 via awireless or wired connection. In turn, the computer 602 may havewireless communications capability to access further computer orinformation networks 607, acting as a bridge to the device 601 a.Alternatively, the device 601 b communicates via a wired or wirelessconnection to a cellphone or 2-way pager 603 which in turn communicateswith a data network 607. Finally, the device 601 c may have a built incommunications means which directly communicates with a data network607. Also shown is the ability of the device 601 e to communicate via awireless link to a printer 621. The device 601 d may also communicatevia the telephone network 606, either directly or via an interfacedevice 604.

The purpose of the communications methods and means, is to access atelephone or data network. The devices 601 communicate either directlyor via a Base Station 608 to a data network, Intranet, or Internet 607.The Base Station 608 may include, or be linked to, a security andidentification system 609, which may include encryption of data, voiceidentity verification and audit trailing of accesses, and other securitymeans, to protect access to patient records and other information andservices.

Many of the purposes and methods associated with the invention andassociated methods include communication with, and use of various data,information and knowledge bases, available locally on an Intranet or viathe Internet or other data network. FIG. 5 shows some of these methodsand elements, as examples. Data requests from devices 601 may betransmitted to a remote computer system 614, which accesses suchdatabases as pharmaceutical data 615, patient data 616, product data617, patient care protocol or standards of care reference material 618,medical research data 619, or medical websites 620, such as those set upby information vendors or manufacturers. A remote patient informationfiltering system 613 is an important part of the methods. The filter 613parses the patient records or physician requests, and generates requeststo the various databases which are filtered and do not containinformation which is patient-identity-specific. This is to protectpatient identity while still being able to access information.

The means for sending information back to professionals and patientsincludes placing information in a custom web page 610, created for therequester, or sending email responses to professionals or patients totheir email addresses 611 and 612. Alternatively, information can besent directly and with little delay to the devices 601.

In some cases, consumers or patients at home might use the system tocommunicate data and measurements. Device 601 d communicates via thetelephone network 606 or data network 607 with a patient care center605. At the patient care center, voice, data, or measurements can bereceived via the telephone or data network and analyzed by a human ormachine. Responses can be given verbally in real time using a telephonehookup, or sent to the patient via a data network to their email accessaddress 612. The analyst 605 can also take control of the measurementdevice 601 d, in order to control the taking of data.

A proprietary aspect of the invention is the combination of the devicewith these data networks and databases to form a new method fordisseminating and recording information, making a connection between thepoint of care, and sources of data and information. The uniqueness ofthe invention lies in the integration of such means to providepoint-of-care access to information. The device itself providesuser-friendly interfaces, and the system as a whole, as shown in FIG. 5,provides the methods and means for information recording and access.

1. A medical diagnostic and communications device for combinedauscultation, voice and remote communications comprising: a portabledevice housing further elements to be used for auscultation and voicecommunications comprising: audio sensor means for convertingauscultation sounds and surrounding voice sounds to electronic signalsto facilitate both auscultation and voice communications, said audiosensor comprising of either a single transducer mounted in the device tofacilitate detection of both auscultation sounds and surrounding voicesounds, or a pair of sensors with a first sensor mounted to primarilydetect auscultation sounds and a second sensor mounted to primarilydetect surrounding voice sounds; audio output means selected from thegroup consisting of loudspeaker, headphones and headphone connection;local control means; digital communications means to providetransmission or reception of remote digital audio signals and remotecontrol messages; electronic processing means operationally connected tosaid audio sensor means and said digital communications means and saidlocal control means, said electronic processing means adapted to performfunctions comprising audio signal mixing, multiplexing, signalprocessing, and sending or receiving and executing remote controlmessages; wherein said local control means or said remote controlmessages direct said electronic processing means to mix, multiplex orprocess electronic signals from said audio sensor means or said remotedigital audio signals such that auscultation sounds, surrounding voicesounds, or remote digital audio signals can be selectively output to atleast one of said audio output means or said digital communicationsmeans such that said portable device can be used for auscultation andvoice communications.
 2. A medical diagnostic and communications devicefor auscultation, voice processing and remote communications comprising:a portable device housing further elements comprising: audio sensormeans for converting auscultation sounds and surrounding voice sounds toelectronic signals to facilitate both auscultation and voicecommunication, said audio sensor means comprising two audio sensors witha first sensor mounted to primarily detect auscultation sounds and asecond sensor mounted to primarily detect surrounding voice sounds;audio output means selected from the group consisting of loudspeaker,headphones, headphone connection and wireless digital communicationsmeans for transmission or reception of remote digital audio signals;local control means; electronic processing means operationally connectedto said audio sensor means and said local control means, said electronicprocessing means including functions to perform audio signal mixing,multiplexing or processing; wherein said local control means directssaid electronic processing means to mix, multiplex or process electronicsignals from said audio sensor means such that auscultation sounds orsurrounding voice sounds can be selectively output to at least one ofsaid audio output means.
 3. A medical diagnostic and communicationsdevice as in claim 1 or 2, wherein a first medical diagnostic andcommunications device at a first location is operatively connected tothe internet via digital communications means; a second, identicalmedical and diagnostic and communications device as in claim 1 or 2 at asecond location is operatively connected to the internet via digitalcommunications means, such that auscultation audio signals, voice audiosignals and remote control messages can be exchanged between said firstand second medical diagnostic and communications devices.
 4. A medicaldiagnostic and communications device as in claim 1 or 2, wherein saidmedical diagnostic and communications device communicates with acellular telephone visa said digital communications means, such thatdigital audio signals, physiological measurements, or remote controlmessages are communicated between said medical diagnostics andcommunications device and said cellular telephone.
 5. A medicaldiagnostic and communications device and cellular telephone as in claim4, wherein said cellular telephone relays digital information betweensaid medical and diagnostics communications device and remote computingdevices via a cellular telephone data network.
 6. A medical diagnosticand communications device as in claim 1 or 2, further comprising digitalaudio recording means for recording auscultation or voice signals suchthat audio recordings can be stored and later transmitted via saiddigital communications means.
 7. A medical diagnostic and communicationsdevice as in claim 1 or 2, wherein said local control means comprises ameans for detecting auscultation audio signal frequency and amplitudeand directing said electronic processing means to selectively mix,multiplex or process auscultation sounds or surrounding voice sounds foroutput, based on the frequency and amplitude characteristics of saidauscultation audio signals.
 8. A combined method for communicationbetween a medical professional and a patient for the purposes of remoteexamination comprising the following steps: first stethoscope withintegrated auscultation, surrounding voice sensing, audio communicationsand control communications means housed within a single device isoperatively connected to a first local internet access device selectedfrom the group consisting of cellular telephone with internet access,handheld computer with internet access, local computer with internetaccess, wired internet access device and wireless internet accessdevice; a second control and voice communications device located at aremote location selected from the group consisting of a secondstethoscope identical to first stethoscope, cellular telephone withinternet access and computer with audio communications means andinternet access, is operatively connected to the internet; an audiocommunications connection is established between said first and a secondinternet access device via an internet connection such that sounds canbe communicated in both directions between said first stethoscope andsaid second control and voice communications device; a controlconnection is established such that said second control and voicecommunications device can control said first stethoscope, such that aremote caregiver co-located with said second control and voicecommunications device can listen to auscultation and voice sounds from apatient or local caregiver co-located with said first stethoscope andoptionally control said first stethoscope, and said patient or localcaregiver can listen to voice communications from said remote caregiverand auscultation sounds from stethoscope via audio output means on saidfirst stethoscope.